Dynamic monitoring of serum tumor markers as prognostic factors in patients with advanced non-small-cell lung cancer treated with first-line immunotherapy: a multicenter retrospective study

Xiongwen Yang; Yi Xiao; Yubin Zhou; Huiyin Deng; Zihao Yuan; Longyan Dong; Jun Lan; Hao Hu; Jian Huang; Shaohong Huang

doi:10.1177/17588359231206282

Dynamic monitoring of serum tumor markers as prognostic factors in patients with advanced non-small-cell lung cancer treated with first-line immunotherapy: a multicenter retrospective study

Ther Adv Med Oncol. 2023 Oct 31:15:17588359231206282. doi: 10.1177/17588359231206282. eCollection 2023.

Authors

Xiongwen Yang^{1

2}, Yi Xiao³, Yubin Zhou³, Huiyin Deng⁴, Zihao Yuan⁵, Longyan Dong⁵, Jun Lan⁶, Hao Hu⁷, Jian Huang⁸, Shaohong Huang⁹

Affiliations

¹ Department of Thoracic Surgery, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China.
² School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
³ Department of Cardio-Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
⁴ Department of Anesthesiology, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁵ The Second Clinical Medical College of Guangdong Medical University, Dongguan, Guangdong, China.
⁶ Department of General Surgery, the People's Hospital of Gaoan City. Gaoan, Jiangxi, China.
⁷ Department of Radiation Therapy, General Hospital of Southern Theater Command, Guangzhou, Guangdong 510000, China.
⁸ Department of Thoracic Surgery, Jiangxi Cancer Hospital, Nanchang, Jiangxi 330029, China.
⁹ Department of Cardio-Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510000, China.

Abstract

Background: To date, no specific studies have reported the use of dynamic serum tumor markers (STMs) as prognostic factors in patients with advanced non-small-cell lung cancer (NSCLC) who receive first-line immunotherapy. Therefore, it is unclear whether STMs can be used as a prognostic factor for first-line immunotherapy in advanced NSCLC.

Objectives: To elucidate the role of STMs in monitoring immunotherapy response in advanced NSCLC. Patients were treated with first-line programmed cell death-1/programmed cell death ligand-1 inhibitors at four Chinese centers.

Design: This was a multicenter retrospective study.

Methods: Blood samples were collected at baseline and after 6-8 weeks of treatment. Computed tomography scans were used to evaluate treatment efficacy according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Post-treatment drops in STMs [Serum carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin fragment 19 (CYFRA21-1), carbohydrate antigen 19-9 (CA19-9), and carbohydrate antigen 125 (CA125)] were decreased ⩾20% (Group C) over baseline was used as cutoff level for defining a marker response. If STMs were increased by ⩾20% after treatment, the therapeutic effect was limited (Group A). Patients with STM changes between a 20% increase or decrease were enrolled in Group B. In univariate and multivariate stepwise Cox regression analyses, STMs and RECIST responses were analyzed for their impact on progression-free survival (PFS) and overall survival (OS).

Results: The analysis included 716 patients. By multivariate analysis, CEA, NSE, CYFRA21-1, CA19-9, and CA125 (Group A versus Group B and Group A versus Group C) were associated with significant differences in PFS. Similar results were observed in the OS analysis. Similar results were observed in the adenocarcinoma subgroup analyses. In squamous cell carcinoma subgroup analyses, there was no statistical difference in PFS (p = 0.147) or OS (p = 0.068) between Group A and Group B for CA125.

Conclusion: The increase and decrease in serum levels of STMs might be reliable prognostic factors for immunotherapy efficacy in NSCLC patients.

Keywords: NSCLC; immunotherapy; serum tumor markers; survival; tumor response.